Research Abstract: Purpose: The purpose of this study was to investigate the relationship of repeated emergency department (ED) utilization and behavioral health comorbidities. Nearly 12 million annual visits to hospital EDs in the United States are related to behavioral health, which encompasses psychiatric disorders and substance abuse. Medicaid recipients are disproportionately represented in studies of ED use and frequent ED use. Little is known about frequent ED visits specifically for Medicaid recipients with behavioral health comorbidities. Design: This ED utilization study was conducted using a cross-sectional, secondary analysis design. Setting: Two counties were selected in the Buffalo, New York metropolitan area. Buffalo is among the poorest cities in the United States. The research team analyzed the two counties’ 2009 Medicaid claims. Participants/Subjects: The Medicaid claims represented 56,491 individuals 18-64 years old. Subjects were stratified into the following cohorts: Healthy (N=28,427), At Risk (N=7,300), Complex Chronic (N=18,795), and System Failure (N=1,969). Demographics of each cohort were as follows: Healthy (34 years, 70% female, 10% ED frequent users), At Risk (45 years old, 57% female, 11% frequent ED users), Chronic (43 years, 68% female, 19% frequent ED users), and System Failure (50 years, 55% female, 23% frequent ED users). Six to 12% of each cohort had a substance abuse claim, 11-30% had mental health comorbidity, and 15-27% were smokers. The study was considered exempt by the Institutional Review Board. Methods: The individual Medicaid recipient was the unit of analysis, and claims were aggregated into individuals. Frequent ED users (those with three or more annual treat-and-release ED visits) were compared to a referent group of low (one annual visit or less) ED users. Using a novel approach, we segmented the population into separate cohorts by chronic disease status using the COMPLEXedexTM algorithm. We tested for the impact of psychiatric disorder, substance abuse, and smoking. Also controlling for age, gender, and numbers of outpatient visits, separate binary logistic regression analyses were performed on each disease complexity cohort. Results/Outcomes: The following factors significantly increased the odds of frequent ED use: Substance Abuse (Odd Ratios=2.4-3.8), Mental Health Comorbidity (Odds Ratios=1.4-2.3), and Smoking (Odds Ratios=1.7-4.0). Implications: Our study adds to the science of ED utilization in 3 ways: 1) we examined the unique effects of behavioral health factors in a Medicaid cohort, as a population vulnerable to frequent treat-and-release ED visits, 2) we gained unique insights into healthier strata of the populations by using a novel complexity algorithm, and 3) we isolated the impact of smoking as a unique substance abuse variable. Our study offers new and corroborating evidence for the need to increase both community and ED care and capacity for substance abuse, mental health, and smoking for the Medicaid population. The results support the need of a behavioral health specialty nurse in the ED, care transitions interventions from the ED to the community, and continued behavioral health education and training for ED providers. Future research is warranted on ED interventions for the behavioral health patient.

This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

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Poster

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The Relationship of Frequent Emergency Department Use and Behavioral Health Comorbidities

Research Abstract: Purpose: The purpose of this study was to investigate the relationship of repeated emergency department (ED) utilization and behavioral health comorbidities. Nearly 12 million annual visits to hospital EDs in the United States are related to behavioral health, which encompasses psychiatric disorders and substance abuse. Medicaid recipients are disproportionately represented in studies of ED use and frequent ED use. Little is known about frequent ED visits specifically for Medicaid recipients with behavioral health comorbidities. Design: This ED utilization study was conducted using a cross-sectional, secondary analysis design. Setting: Two counties were selected in the Buffalo, New York metropolitan area. Buffalo is among the poorest cities in the United States. The research team analyzed the two counties’ 2009 Medicaid claims. Participants/Subjects: The Medicaid claims represented 56,491 individuals 18-64 years old. Subjects were stratified into the following cohorts: Healthy (N=28,427), At Risk (N=7,300), Complex Chronic (N=18,795), and System Failure (N=1,969). Demographics of each cohort were as follows: Healthy (34 years, 70% female, 10% ED frequent users), At Risk (45 years old, 57% female, 11% frequent ED users), Chronic (43 years, 68% female, 19% frequent ED users), and System Failure (50 years, 55% female, 23% frequent ED users). Six to 12% of each cohort had a substance abuse claim, 11-30% had mental health comorbidity, and 15-27% were smokers. The study was considered exempt by the Institutional Review Board. Methods: The individual Medicaid recipient was the unit of analysis, and claims were aggregated into individuals. Frequent ED users (those with three or more annual treat-and-release ED visits) were compared to a referent group of low (one annual visit or less) ED users. Using a novel approach, we segmented the population into separate cohorts by chronic disease status using the COMPLEXedexTM algorithm. We tested for the impact of psychiatric disorder, substance abuse, and smoking. Also controlling for age, gender, and numbers of outpatient visits, separate binary logistic regression analyses were performed on each disease complexity cohort. Results/Outcomes: The following factors significantly increased the odds of frequent ED use: Substance Abuse (Odd Ratios=2.4-3.8), Mental Health Comorbidity (Odds Ratios=1.4-2.3), and Smoking (Odds Ratios=1.7-4.0). Implications: Our study adds to the science of ED utilization in 3 ways: 1) we examined the unique effects of behavioral health factors in a Medicaid cohort, as a population vulnerable to frequent treat-and-release ED visits, 2) we gained unique insights into healthier strata of the populations by using a novel complexity algorithm, and 3) we isolated the impact of smoking as a unique substance abuse variable. Our study offers new and corroborating evidence for the need to increase both community and ED care and capacity for substance abuse, mental health, and smoking for the Medicaid population. The results support the need of a behavioral health specialty nurse in the ED, care transitions interventions from the ED to the community, and continued behavioral health education and training for ED providers. Future research is warranted on ED interventions for the behavioral health patient.

This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

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